title: Comparison between cervical total disc replacement and anterior cervical discectomy and fusion of 1 to 2 levels from 2002 to 2009.
abstract: METHODS
  Retrospective database analysis.
  
  
  OBJECTIVE
  To compare the perioperative patient characteristics, early postoperative outcomes, and costs between anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (TDR) in the United States.
  
  
  BACKGROUND
  Cervical TDR and ACDF are indicated to treat symptomatic cervical degenerative pathology. The epidemiology, complication rates, and the cost differences between the 2 surgical approaches are not well characterized.
  
  
  METHODS
  Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was queried from 2002 to 2009. Patients undergoing cervical TDR or ACDF of 1 to 2 levels were identified. Patient demographics, comorbidities, length of stay, costs, and the in-hospital complications were assessed. SPSS (version 20) was used for statistical analysis with χ test for categorical data and independent-samples t test for continuous data. A value of P ≤ 0.001 denoted statistical significance. Multinomial regression analysis was used to identify the independent risk for complications in the TDR cohort compared with the ACDF cohort.
  
  
  RESULTS
  There were 141,230 ACDF cases of 1 to 2 levels and 1830 cervical TDR cases identified in the Nationwide Inpatient Sample database. The ACDF cohort was older and demonstrated a greater comorbidity burden than the TDR group (P < 0.001). The ACDF-treated patients demonstrated a significantly greater length of stay than the TDR group (P < 0.001). In contrast, there were no significant differences in the incidence of postoperative complications, mortality, or hospital costs between the surgical cohorts. Multinomial regression did not demonstrate significant differences in the risk for postoperative complications between the surgical techniques.
  
  
  CONCLUSIONS
  The ACDF cohort was significantly older and demonstrated a greater comorbidity burden that likely contributed to the greater length of stay when than the TDR cohort. Both cohorts demonstrated comparable incidences of early postoperative complications and costs. There were no significant differences in the risks for postoperative complications between the surgical cohorts. Further studies are warranted to characterize the long-term complications, costs, and patient outcomes between the 2 surgical techniques.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Sreeharsha V
authors.initials: SV
authors.lastname: Nandyala
authors.forename: Alejandro
authors.initials: A
authors.lastname: Marquez-Lara
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fineberg
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D055959:Intervertebral Disc Degeneration / Q000191:economics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D059145:Total Disc Replacement / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult